Sex Differences in the Prevalence, Outcomes and Management of Hypertension

Abstract

Purpose of review: To review recent data on sex differences in the prevalence, outcomes and management of hypertension.

Recent findings: Although hypertension is overall more common in males, females experience a much sharper incline in blood pressure from the third decade of life and consequently the prevalence of hypertension accelerates comparatively with age. Mechanisms responsible for these blood pressure trajectories may include the sustained vascular influence of hypertensive disorders of pregnancy, interactions between the renin-angiotensin-aldosterone system and sex hormones or even psychosocial gendered factors such as socioeconomic deprivation. Moreover, the impact of hypertension is not uniform and females are at higher risk of developing a multitude of adverse cardiovascular outcomes at lower blood pressure thresholds. Blood pressure is a sexually dimorphic trait and although significant differences exist in the prevalence, pathophysiology and outcomes of hypertension in males and females, limited data exist to support sex-specific blood pressure targets.

Keywords: Blood pressure; Gender; Hypertension; Sex.

Fig. 1

Sex differences in hypertension. There is sexual dimorphism in hypertension prevalence [9], rate of development in hypertension [15] and significant hazard ratios (HR) of incident CVD [40]. Although hypertension remains more common in males, the gradient by which hypertension develops across the lifespan in females is steeper, while the blood pressure thresholds at which CVD develops are lower. These differences may be related to sex-specific risk factors such as hypertensive disorders of pregnancy and the menopause